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Download Implementing Change in Health Systems: Market Reforms in the by Michael I. Harrison PDF

By Michael I. Harrison

Imposing swap in health and wellbeing structures brings clean pondering and proof to the ongoing debate approximately marketplace reforms of wellbeing and fitness care and different public companies. The ebook examines the improvement and implementation of nationwide cost-containment courses and overall healthiness procedure reorganizations within the united kingdom, Sweden and the Netherlands — international locations which were leaders in well-being method reform.

The publication presents a brand new framework for examining public coverage implementation and approach swap, synthesizing assorted streams of educational learn and pondering. It explores the methods of enforcing marketplace reforms in each one kingdom and considers the results, either anticipated and accidental. In all 3 international locations aggressive reform encountered severe technical, organizational and political stumbling blocks. but they caused very important procedure alterations and lead the way for major new wellbeing and fitness rules.

The advanced results of the reforms integrated:

• alterations within the caliber, potency and prices of care • transforming into managerial and political keep watch over over physicians and different healthiness care execs • elevated effect and centrality of community-based care • Diffusion of principles and practices from enterprise administration into wellbeing and fitness care.

Implementing switch in overall healthiness platforms sheds new mild on the most important coverage concerns which are presently being debated within the usa and plenty of different nations. The e-book may be of price to scholars, researchers, and practitioners in wellbeing and fitness coverage and public coverage.

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Extra info for Implementing Change in Health Systems: Market Reforms in the United Kingdom, Sweden and The Netherlands

Sample text

Until 1990 they were supervised and paid by a separate national agency. Hospital specialists, although salaried, can also maintain private practices and hospitalize patients in private beds within state hospitals. Partly in response to tight NHS funding, expenditures for private, for-profit care grew rapidly during the 1980s (OECD, 1992, p. 116). In 1989 around 13% of the population had some form of private health insurance (Ham, 1992, p. 47). 2 Major health system features before the market reforms Delivery Regulation United Kingdom General taxation by national government; 15% from private sources1 Finance Hospitals: public, salaried physicians & nurses; some private physicians (paid fee for service), some private beds in state & private hospitals Primary care: self-employed physicians own clinics & contract with national government (mix of capitation, fixed pay, fee for service) Department of Health oversees National Health Service (NHS); NHS hierarchy oversees districts, which operate most general hospitals; separate government agency pays & supervises general practitioners.

Qxd 8/7/2006 8:08 PM Page 34 IMPLEMENTING CHANGE IN HEALTH SYSTEMS 34 new GP contract aimed at further strengthening the role of health promotion within primary care by providing incentives for GPs to carry out specific forms of preventive care and minor surgery (Farmer, 1993; Silcock and Ratcliffe, 1996). , 1994). To further enhance sectoral integration, in 1996 the government put the agency responsible for financing and supervising GPs under the Regional Health Authorities, which also supervised the HAs.

3 Purchasing power parities, see Chapter 1, footnote 24. 4 Includes day patients. 5 Ambulatory visits; excludes private visits for UK, excludes maternal and child care for Sweden and Netherlands. 3 refer to 1987, just before the start of the market reforms. Appendix C provides comparative data from the late 1990s. 1. 25 During the early 1980s Sweden and the Netherlands greatly exceeded European and OECD average expenditure levels and provided generous health resources to their citizens. The fact that both countries had fewer beds per capita in 1987 than the OECD average mainly reflects budgetary restraints imposed during the 1980s.

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